Population-based surveillance for scedosporiosis in Australia: epidemiology, disease manifestations and emergence of Scedosporium aurantiacum infection.

Australia-wide population-based surveillance for scedosporiosis identified 180 cases, with 118 (65.6%) cases of colonization and 62 (34.4%) cases of infection. Predisposing factors for isolation of Scedosporium spp. included chronic lung disease in 37.8% and malignancy in 21.7% of cases. Predictors of invasive disease (n=62) included haematological stem cell transplantation (n=7), leukaemia (n=16) and diabetes mellitus (n=8). Of 183 phenotypically-speciated isolates, 75 (41%) were Scedosporium prolificans (risk factors: haematologic cancer (n=17), neutropaenia (n=14)) and 108 (59%) had Scedosporium apiospermum/Pseudallescheria boydii phenotype [risk factor: diabetes (n=15)]. Scedosporium prolificans (p 0.01) and leukaemia (p 0.03) independently predicted death. Epidemiological and antifungal susceptibility profiles of Scedosporium aurantiacum (prevalence>or=15.8%) and S. apiospermum were similar. No patient with S. aurantiacum infection (n=6) died. This is the first description of clinical features associated with S. aurantiacum.

Breakthrough Scedosporium prolificans infection while receiving voriconazole prophylaxis in an allogeneic stem cell transplant recipient.

Breakthrough invasive fungal infections among patients with hematologic malignancies receiving voriconazole are being reported with increasing frequency, with zygomycete infections predominating. We report a case of disseminated Scedosporium prolificans infection in a patient receiving voriconazole prophylaxis. Despite poor in vitro activity of voriconazole for this organism, synergy studies using the checkerboard method demonstrated synergy with the combination of voriconazole and terbinafine. This regimen, in conjunction with central venous line removal and intravitreal voriconazole, contributed to the recovery of the patient. S. prolificans is a life-threatening mold that should be considered in patients with breakthrough invasive fungal infections while on voriconazole prophylaxis.

Integrated home monitoring predicts lead failure in a pacemaker dependent 4-year-old girl.

A 4-year-old girl with post-surgical complete atrioventricular block received an epicardial dual chamber pacemaker system. During further growth intermittent exit block occurred, first misinterpreted as neurological seizures. The epicardial lead was replaced using a transvenous approach, and a pacemaker with an integrated home monitoring facility was implanted. After her discharge, a rise in the pacing threshold automatically initiated an event message. On the basis of this information, the patient was called in and imminent dislodgement of the ventricular lead was diagnosed by x-ray. The lead was repositioned and was found stable over 1-year follow-up.

[Quality assurance in therapy of mucoviscidosis: value of the Bonn patient information system]. / Qualitätssicherung in der Mukoviszidosetherapie: Stellenwert des Patienten-Informations-Systems Bonn.

BACKGROUND: Differences in the survival rates of patients in two large CF-clinics (Toronto, Boston) were explained by differences in dietary regimens: Toronto favoured a fat-enriched diet and had the better outcome. This example may explain how important high quality medical data are for improving treatment and prognosis of CF. AIM: A local patient-information-system is described to improve internal and external quality control. RESULTS: The system was developed over years in a fruitful collaboration between a realistic statistician and active CF doctors. It is easy to use and facilitates documentation, follow-up, researches and preparation of data for scientific presentation and clinical routine. Graphical outline may be used to motivate individual patients. Internal controlling for plausibility improves quality of data also serving the national system for quality control. CONCLUSIONS: We believe, our system is able to improve internal quality control and to serve the national system for quality control very efficiently without additional workload of the local CF-clinic.